Faculty Bibliography

Global study data show injection drug use is driving upwards of 79% of all new HCV cases in high-income countries. Low-threshold models can engage vulnerable populations in treatment to achieve HCV elimination targets. We examined the implementation of low-threshold models for HCV care in New York State, which has a robust HCV elimination program.We conducted semi-structured interviews with 16 healthcare providers in 2022. Included providers either self-described as “low-threshold,” had a clinical focus on marginalized populations, or practiced in non-traditional settings. Interviews focused on the implementation of low-threshold HCV care. Transcripts were analyzed using thematic analysis and were categorized into themes guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.Providers implemented low-threshold HCV care by facilitating access, e.g. having walk-in or telemedicine HCV services. Point-of-care testing and peer support were other important features. The inner context was driven by provider and organization values, and involved providing low-threshold HCV care within health systems that were not themselves “low-threshold.” Adequate staffing was crucial for the extensive care coordination and outreach activities needed to engage PWID. The outer context was characterized by a limited funding environment, restrictive insurance policies, and the high impact of patients’ unmet social needs. Providers relied on care coordination and integrated care models to overcome these barriers.Low-threshold HCV care incorporates operational flexibility and patient navigation, but is challenged by patients’ unmet social needs. Jurisdictions can support implementation by providing adequate funding for substantial outreach activities needed to engage vulnerable populations

BACKGROUND:Changing from standing to sitting positions requires rotation of the femur from an almost vertical plane to the horizontal plane. Osteoarthritis of the hip limits hip extension, resulting in less ability to recruit spinopelvic tilt (SPT) while standing and requiring increased SPT while sitting to compensate for the loss of hip range of motion. To date, the effect of total hip arthroplasty (THA) on spinopelvic sitting and standing mechanics has not been reported, particularly in the setting of patients with coexistent sagittal plane spinal deformity. METHODS:A retrospective review was performed of patients ≥18 years of age undergoing unilateral THA for hip osteoarthritis with sitting and standing radiographs made before and after THA. Alignment was analyzed at baseline and follow-up after THA in both standing and sitting positions in a relaxed posture with the fingers resting on top of the clavicles. Patients were grouped according to the presence or absence of sagittal plane deformity preoperatively into 3 groups: no sagittal plane deformity (normal), thoracolumbar (TL) deformity (pelvic incidence-lumbar lordosis [PI-LL] mismatch > 10° and/or T1-pelvic angle [TPA] > 20°), or apparent deformity (PI-LL ≤ 10° and TPA ≤ 20°, but sagittal vertical axis [SVA] > 50 mm). RESULTS:In this study, 192 patients were assessed: 64 had TL deformity, 39 had apparent deformity, and 89 had normal alignment. Overall, patients demonstrated a reduction in standing SVA (45 to 34.1 mm; p < 0.001) and an increase in SPT (14.6° to 15.7°; p = 0.03) after THA. There was a greater change in standing SVA (p < 0.001) among patients with apparent deformity (-29.0 mm) compared with patients with normal alignment (0.9 mm) and patients with TL deformity (-16.3 mm). Those with apparent deformity also experienced the greatest difference (p = 0.03) in postural SPT change (moving from standing to sitting) (-10.1°) from before to after THA when compared with those with normal alignment (-3.6°) and TL deformity (-1.2°). The difference in postural SVA change from before to after THA was also greatest (p < 0.001) in those with apparent deformity (32.1 mm) compared with those with normal alignment (6.5 mm) and TL deformity (17.3 mm). CONCLUSIONS:Postural changes in spinopelvic alignment vary after THA depending on the presence of TL deformity or apparent deformity due to hip flexion contracture. Patients with apparent deformity had larger changes in standing and sitting alignment than patients with TL deformity or patients with normal alignment. The assessment of global sagittal alignment findings can be used to predict the likelihood of improvement in sagittal alignment after THA. LEVEL OF EVIDENCE/METHODS:Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

This review aims to compare current evidence for the use of corticosteroid injection (CSI) versus platelet-rich plasma (PRP) in the treatment of common pathologies of the shoulder, hip and knee.

BACKGROUND:Coronary artery disease (CAD) is a highly prevalent condition which can lead to myocardial ischemia as well as acute coronary syndrome. Early diagnosis of CAD can improve patient outcomes through guiding risk factor modification and treatment modalities. SUMMARY/CONCLUSIONS:Testing for CAD comes with increased cost and risk; therefore, physicians must determine which patients require testing, and what testing modality will offer the most useful data to diagnose patients with CAD. Patients should have an initial risk stratification for pretest probability of CAD based on symptoms and available clinical data. Patients with a pretest probability less than 5% should receive no further testing, while patients with a high pretest probability should be considered for direct invasive coronary angiography. In patients with a pretest probability between 5 and 15%, coronary artery calcium score and or exercise electrocardiogram can be obtained to further risk stratify patients to low-risk versus intermediate-high-risk. Intermediate-high-risk patients should be tested with coronary computed tomography angiography (preferred) versus positron emission tomography or single photon emission computed tomography based on their individual patient characteristics and institutional availability. KEY MESSAGES/CONCLUSIONS:This comprehensive review aimed to describe the available CAD testing modalities, detail their risks and benefits, and propose when each should be considered in the evaluation of a patient with suspected CAD. BACKGROUND:Coronary artery disease (CAD) is a highly prevalent condition which can lead to myocardial ischemia as well as acute coronary syndrome. Early diagnosis of CAD can improve patient outcomes through guiding risk factor modification and treatment modalities. SUMMARY/CONCLUSIONS:Testing for CAD comes with increased cost and risk; therefore, physicians must determine which patients require testing, and what testing modality will offer the most useful data to diagnose patients with CAD. Patients should have an initial risk stratification for pretest probability of CAD based on symptoms and available clinical data. Patients with a pretest probability less than 5% should receive no further testing, while patients with a high pretest probability should be considered for direct invasive coronary angiography. In patients with a pretest probability between 5 and 15%, coronary artery calcium score and or exercise electrocardiogram can be obtained to further risk stratify patients to low-risk versus intermediate-high-risk. Intermediate-high-risk patients should be tested with coronary computed tomography angiography (preferred) versus positron emission tomography or single photon emission computed tomography based on their individual patient characteristics and institutional availability. KEY MESSAGES/CONCLUSIONS:This comprehensive review aimed to describe the available CAD testing modalities, detail their risks and benefits, and propose when each should be considered in the evaluation of a patient with suspected CAD.

Development takes place when change in one domain cascades into change in another domain. Preterm infants exhibit disruptions to their object play and the maintenance of a joint focus of attention with another person. Likewise, they tend to experience cognitive delays throughout childhood. By the developmental cascades model, early features of object play and joint engagement in preterm infants predict cognitive development. We examined longitudinal associations between real-time individual differences in parent-infant interactions and long-term outcomes to explore potential developmental processes. Features of infant-object interactions and joint engagement were coded in 20 12-month-old preterm infants (≤ 29 weeks of gestation) during parent-infant free play. Infants were tested again at 30 months using the Bayley Scales of Infant and Toddler Development, Third Edition. Preterm infants spent most of their time interacting with objects at 12 months, and their parents frequently engaged in their object interactions. The frequency of infant-object interaction bouts per minute at 12 months was negatively associated with 30-month cognitive scores. Furthermore, the percentage of infant-object interaction bouts in which parents practised multimodal engagement was marginally associated with 30-month cognitive scores. We discuss the associations of infant-object interactions and joint engagement with preterm infants' cognitive development.

The value of preclinical diffusion MRI (dMRI) is substantial. While dMRI enables in vivo non-invasive characterization of tissue, ex vivo dMRI is increasingly being used to probe tissue microstructure and brain connectivity. Ex vivo dMRI has several experimental advantages including higher SNR and spatial resolution compared to in vivo studies, and enabling more advanced diffusion contrasts for improved microstructure and connectivity characterization. Another major advantage of ex vivo dMRI is the direct comparison with histological data, as a crucial methodological validation. However, there are a number of considerations that must be made when performing ex vivo experiments. The steps from tissue preparation, image acquisition and processing, and interpretation of results are complex, with many decisions that not only differ dramatically from in vivo imaging of small animals, but ultimately affect what questions can be answered using the data. This work represents "Part 2" of a three-part series of recommendations and considerations for preclinical dMRI. We describe best practices for dMRI of ex vivo tissue, with a focus on the value that ex vivo imaging adds to the field of dMRI and considerations in ex vivo image acquisition. We first give general considerations and foundational knowledge that must be considered when designing experiments. We briefly describe differences in specimens and models and discuss why some may be more or less appropriate for different studies. We then give guidelines for ex vivo protocols, including tissue fixation, sample preparation, and MR scanning. In each section, we attempt to provide guidelines and recommendations, but also highlight areas for which no guidelines exist (and why), and where future work should lie. An overarching goal herein is to enhance the rigor and reproducibility of ex vivo dMRI acquisitions and analyses, and thereby advance biomedical knowledge.

INTRODUCTION/BACKGROUND:Acute esophageal necrosis (AEN) is a rare and lethal condition that may progress to sepsis and perforations. Most related literature comes from case reports; however, a few small reviews have been published. We conducted a large systematic review of AEN using PubMed, Medline, and Embase to organize data into one consolidated manuscript, find potential prognosticators of illness, and determine possible treatment guidelines for AEN. METHODS:Advanced searches were performed of all English case reports from 1990 to 2021 using medical subject heading terms. Data on patient age, sex, comorbidities, initial presentation, management, progression of illness, and hospital survival were collected. RESULTS:Our study included 226 articles, encompassing 319 cases. A total of 32.3% of patients had diabetes, 26.6% had hypertension, and 19.7% had alcohol use disorder. Overall, 66.5% presented with an upper gastrointestinal bleed and 21.9% developed sepsis or esophageal perforation. In total, 60.9% of patients were reported to have survived their illness, but 16.6% of cases did not have their discharge status documented. Interestingly, patients presenting with pain or ketoacidosis demonstrated improved survival. CONCLUSION/CONCLUSIONS:AEN becomes more prevalent as patients age and develop cardiovascular disease, which increases the risk of developing a hypoperfusive state and mucosal injury to the distal esophagus. Early fluid resuscitation, acid-reducing agents, and bowel rest may serve as potential lifesaving interventions, and antibiotics should be considered if there is concern for infection. Patients require close follow-up in anticipation of impending stricture. INTRODUCTION/BACKGROUND:Acute esophageal necrosis (AEN) is a rare and lethal condition that may progress to sepsis and perforations. Most related literature comes from case reports; however, a few small reviews have been published. We conducted a large systematic review of AEN using PubMed, Medline, and Embase to organize data into one consolidated manuscript, find potential prognosticators of illness, and determine possible treatment guidelines for AEN. METHODS:Advanced searches were performed of all English case reports from 1990 to 2021 using medical subject heading terms. Data on patient age, sex, comorbidities, initial presentation, management, progression of illness, and hospital survival were collected. RESULTS:Our study included 226 articles, encompassing 319 cases. A total of 32.3% of patients had diabetes, 26.6% had hypertension, and 19.7% had alcohol use disorder. Overall, 66.5% presented with an upper gastrointestinal bleed and 21.9% developed sepsis or esophageal perforation. In total, 60.9% of patients were reported to have survived their illness, but 16.6% of cases did not have their discharge status documented. Interestingly, patients presenting with pain or ketoacidosis demonstrated improved survival. CONCLUSION/CONCLUSIONS:AEN becomes more prevalent as patients age and develop cardiovascular disease, which increases the risk of developing a hypoperfusive state and mucosal injury to the distal esophagus. Early fluid resuscitation, acid-reducing agents, and bowel rest may serve as potential lifesaving interventions, and antibiotics should be considered if there is concern for infection. Patients require close follow-up in anticipation of impending stricture.